1. Routine Laboratory Tests
1.1 Semen Analysis
At first physical examination is conducted and then laboratory testing should be held. For the evaluation of the semen laboratory analysis should be held. The semen analysis does not consider being a test for fertility. Fertility determination should be held for a couple and the initiation of a pregnancy is recommended for the purpose. The best results can be achieved uniting a female factor evaluation with of the male one.
2-3 days are required to take all specimens and to evaluate them of sperm motility and forward progression within 2 hours of collection that is held at the laboratory. Specimen container should be clean, sterility is not required. Some plastics have residual spermatocidal chemicals in their content and may include spermatotoxic contaminating material as one of their constituences. The collection of the semen is held by masturbation, coitus interruptus, or with a special condom avoid of spermatocidal constituences.
"Normal" (average) and "adequate" (potentially fertile) semen quality differ. A mean or average sperm density is important because of semen quality. The results can be achieved without any difficulty. Sexual abstinence is not controlled and does not demand complete ejaculation. The age of such men is more comparing with men who have fertility evaluation.
Men with high-quality spermatozoa have fertility with very low sperm densities.
1.2. Basic Laboratory Tests
One should begin laboratory investigation of testicular function with basic screening tests. The clinical history and physical examination are the factors influencing the tests’ results. The hormones that are recommended to be tested are testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH).
Serum T is responsible for Leydig cell function and indicates intratesticular testosterone. The levels of measured circulating LH and FSH are necessary to find out if a patient's endocrine dysfunction appears as the result of primary testicular failure or hypothalamic and/or pituitary deficiency.
Other tests are also recommended. The measurement of serum prolactin is recommended for patients with signs and symptoms of a pituitary tumor, patients whose serum testosterone level is low and whose do not have elevated serum LH that does not have any connection with it and for patients consuming psychotropic drugs or centrally acting antihypertensives.
An evaluation of other pituitary hormones (adrenocorticotropic hormone [ACTH], thyroid-stimulating hormone [TSH], and growth hormone [GH]) is required for all patients who have hypogonadotropic hypogonadism (LH and FSH deficiency).
2. Additional Laboratory Tests
Between 10% and 20% of infertile couples were evaluated and it was observed that they suffer from "unexplained" infertility. The female infertility has lower data due to techniques held to find out the effectiveness of evaluation. During the male infertility one should pay attention to sperm number and motility, the determination conducted by routine semen analysis and the definition of function or true sperm quality. That’s why tests are required for the identification of other abnormalities of semen parameters. These tests are leukocyte, tests of sperm function and antisperm antibody identification.
2.1. Quantitation of Leukocytes in Semen
The identification of leukocytes in semen has been conducted with monoclonal antibody technology. Some patients, who suffer from infertility, have a lot of round cells in their semen. One may make a difference between immature germ cells and leukocytes conducted with a standard semen analysis. The cell type should be determined due to pyospermia considered as infection. It was found out that infertile men have higher white blood cell counts in their ejaculates comparing with normal men.
2.2. Antisperm Antibody Testing
There is a connection between antisperm antibodies (ASA) in the semen and lower pregnancy rates. It may be a result of some risk factors, such as previous genital infections, testicular trauma or biopsy, heat-induced testicular damage, or genital tract obstruction. ASA may also be found out after semen analysis with clumping/agglutination, diminished motility, a poor postcoital test, or the availability of the "shaking" phenomenon on sperm-cervical cross-mucus testing.
These antibodies have been detected with various methods, the most accurate analyze is the immunobead test. Its purpose is the utilization of polyacrylamide beads to which rabbit antihuman antibodies have been connected. It makes possible the acute detection of IgA or IgG antibody connected with the head, midpiece, or tail of motile sperm. More than 20%-50% of sperm demonstrating immunobead binding is not important. Tests evaluating antisperm antibodies in the serum or seminal plasma are not as important as sperm-bound antibody analyzes due to the sperm surface antibodies that have an ability to produce the functional deficits that are connected with immunologic infertility.
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